Summary: A new study in US veterans shows that EAET is quite effective for pain relief in hard cases. These are patients with pain plus mental health problems. The gains hold up over time. This therapy also beats CBT for chronic pain by a wide margin.
A new randomized clinical trial confirms that Emotional Awareness and Expression Therapy (EAET) works for chronic pain. It helps most in so-called psychiatrically complex patients. These are people living with chronic pain plus several mental health problems.
We have long known that chronic pain, unlike sudden short-term pain, needs a broad approach. Emotional problems play a big role in it. That is why doctors often use antidepressants, anti-anxiety drugs, and other mood-focused therapies for these patients.
Therapies without drugs are safer than pills and often work better. But they take long, steady effort. They are also harder to put in place.
The study was published in the JAMA Network Open. It ran among veterans from 2019 to 2023. Every patient was a complex case. Each one had chronic pain plus other problems like anxiety, depression, PTSD, and other mental health issues. The study found that EAET beats cognitive behavioral therapy (CBT) for chronic pain in these patients.
CBT is a common, proven talk therapy for mental health. It tries to change how a patient thinks and acts. EAET works a different way. It digs into feelings, including painful past events. The patient gains a clearer sense of those feelings. The body follows: health gets better and pain drops.
The study had 126 people, mostly men. Almost half were African American. Their average age was 72 years. Most patients finished the treatment. The big surprise came at the six-month follow-up. EAET gave far more pain relief than CBT (63% vs. 17%). Since the gap is that large, it is fair to say EAET works much better.
The researchers found more. In many patients, certain emotional reactions make the pain worse. Most of these people live with anxiety, depression, and PTSD. Once patients see how their feelings feed the pain, they beat the pain more easily.
With the right teaching and training, patients learn to spot their emotional triggers. They also handle stress better. The result is better and faster pain control.
Of course, the worse the emotional symptoms, the more therapy it takes. People with deeper emotional problems need more weeks and longer sessions. Many of them may not improve much at first. They need time to work through their emotional problems.
In EAET, patients learn to understand and voice the feelings tied to their pain. This lets them tackle the hidden causes that start the pain or make it worse over time. EAET handles emotional problems better. So it is also linked to better pain relief over the long haul.
Of course, this study has limits. Most of the people in it were older adults and veterans.
But the researchers noted one clear plus of EAET – it can be delivered through telehealth platforms. Now they are testing these new ways to deliver EAET. That could help far more people.
Frequently asked questions
How does emotional awareness and expression therapy work?
In EAET, patients learn to understand and voice the feelings tied to their pain, including painful past events. Once a patient sees how feelings feed the pain, they learn to spot their triggers. They handle stress better too. That work goes after the things that cause pain or make it worse over time.
Is EAET better than CBT for chronic pain?
In this trial, yes, by a wide margin. The study had 126 US veterans with an average age of 72. At six months, 63% of the EAET group had pain relief. Only 17% of the cognitive behavioral therapy (CBT) group did. CBT works on thoughts and habits. EAET works on the feelings under the pain.
Who benefits most from emotional awareness and expression therapy?
EAET helps most in psychiatrically complex patients. These are people with chronic pain plus anxiety, depression, PTSD or other mental health issues. The worse the emotional symptoms, the longer the therapy and the sessions. Some patients gain little at first. They need time before the pain relief follows.
Can EAET be done through telehealth?
Yes. One clear plus of EAET is that it can be delivered through telehealth platforms. Researchers are now testing these remote ways to deliver it. The goal is to reach many more people living with chronic pain.
Source:
Yarns, B. C., Jackson, N. J., Alas, A., Melrose, R. J., Lumley, M. A., & Sultzer, D. L. (2024). Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open, 7(6), e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842
Dr. Gurpreet Singh Padda, MD, MBA, MHP
